368-215_Harnett Checklist Collocation.11092017Harnett County North Carolina Communications Facility
Collocation Application Checklist
HCWFC-04
Date Submitted: ____________________________
APPLICANT’S NAME: ________________________________________________________________________________
Phone: _______________________ FAX: _____________________ E-mail: _____________________________
PROPERTY OWNER: _______________________________________________Phone: ___________________________
APPLICANT'S CONTACT: ____________________________________________________________________________
Address____________________________________________________________________________________
Phone: _______________________ FAX: _____________________ E-mail: _____________________________
Lessor/Licensor Contact Information:
Name: ______________________________________________________________________________________
Address: ___________________________________________________________________________________
Phone: _______________________ FAX: ______________________ E-mail: ____________________________
Commercial Wireless Provider ________________________________________________________________
Co-location: Yes [ ] No [ ] Water Tower: Yes [ ] No [ ]
Replace Existing Structure: Yes [ ] No [ ] Replacement (upgrade) of existing antennas Yes [ ] No [ ]
FACILITY INFORMATION:
Site Address: _______________________________________________________________________________________
Latitude (NAD83): _________________________________Longitude (NAD83): _________________________________
Ground Elevation (AMSL) (ft): _______________________Total Height of Tower: (AGL) (ft) ______________________
RAD Center (ft): _____________________________________________________________________________________
TAX Parcel Identification Number: _____________________________________________________________________
Present Zoning of Property: __________________________________________________________________________
Land Use and Description of Property: _________________________________________________________________
FCC Antenna Structure Registration Number (ASR) (if applicable): __________________________________________
The following must be enclosed with this application:
1. A statement (electronic preferable) from a qualified individual that the applicant will comply with all FCC
rules regarding human exposure to RF energy, along with the individual’s qualifications.
2. A statement (electronic preferable) from the applicant that the applicant will comply with all applicable FCC
rules regarding radio-frequency interference;
3. Complete Construction Drawings of the proposed changes;
4. A structural certification by a Registered Professional Engineer that the facility complies and will continue
to comply with EIA/TIA-222-F (as amended) for Harnett County, NC.
5. A completed “County of Harnett Land Use Application” and Application Fee
Received: ___________________________________________ ___ ____________
Harnett County Planning Department Date
Please Note: Supplemental information may be requested for purposes of clarity or confirmation.